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Prostate Biopsy and the Gleason Score: What You Should Know

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A biopsy is used to detect the presence of cancer cells in the prostate and to evaluate how aggressive cancer is likely to be. Thanks to an array of biopsy techniques and new tools to interpret the results, doctors are better able to predict when cancers are slow-growing and when they’re likely to be aggressive. That information, in turn, can help you and your doctor choose the best course of treatment.

Before having a prostate biopsy performed, most men have undergone other tests for prostate cancer. PSA tests, for example, measure a substance called prostate-specific antigen in the bloodstream. Abnormally high levels may signal the presence of cancer. Because PSA levels are higher in men with larger prostate glands, doctors also use a test called PSA density, which relates PSA level to the size of the gland. A digital rectal exam, in which the doctor inserts a gloved lubricated finger into the rectum, is used to detect unusual bumps or hard areas on the prostate that might be cancer. If these tests raise concern, the next step is a prostate biopsy.

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How a biopsy is performed

The goal of a biopsy is to remove small samples of prostate tissue so that it can be examined under a microscope for signs of cancer. In the most commonly performed procedure, a needle is inserted through the wall of the rectum into the prostate gland, where it removes a small cylinder of tissue.

The biopsy needle can also be inserted through the skin between the rectum and the scrotum, an area called the perineum. In order to sample tissue throughout the gland, 12 or more core samples are typically removed from different parts of the prostate. To guide the procedure, doctors view an ultrasound image of the gland on a video screen as they manipulate the needle.

Most biopsies are performed in an urologist’s office. The procedure, which only takes about 15 minutes, may cause some discomfort but not serious pain. Your doctor may prescribe an antibiotic medicine to take one day before and a few days after the procedure. You may experience a little soreness afterward, and you may notice blood in your urine or semen for a few weeks.

Deciphering the Results

Biopsied tissue is sent to a laboratory, where a pathologist views the cells under a microscope. When healthy cells become cancerous, their appearance begins to change. The more altered the cells look, the more dangerous the cancer is likely to be.

The results from a prostate biopsy are usually given in the form of the Gleason score. On the simplest level, this scoring system assigns a number from 2 to 10 to describe how abnormal the cells appear under a microscope. A score of 2 to 4 means the cells still look very much like normal cells and pose little danger of spreading quickly. A score of 8 to 10 indicates that the cells have very few features of a normal cell and are likely to be aggressive. A score of 5 to 7 indicates intermediate risk.

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